Eyeworld CME Supplements

EW SEP 2017 - Supported by unrestricted educational grants from Allergan, Shire Pharmaceuticals, TearLab, and TearScience

This is a supplement to EyeWorld Magazine that doctors can take a test after reading and receive CME credits for.

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2 The third refractive surface: Improving surgical outcomes with advanced diagnostics and therapeutics pleased with her vision. Grittiness and a foreign body sensation developed after surgery, and she continues maintenance therapy for long-term dry eye. Conclusion Refractive cataract surgeons cannot perform premium sur- gery without a premium ocular surface. To deliver the surgical outcomes patients anticipate, refractive cataract surgeons need to take the steps necessary to identify and effectively treat dry eye before performing preopera- tive measurements. Dr. Donnenfeld practices with Ophthalmic Consultants of Long Island and Connecticut and is clinical professor of ophthalmology, New York University, New York. He can be contacted at ericdonnenfeld@ gmail.com. cause this problem. Her vision also fluctuated. Osmolarity was 322 and 311 mOsm/L. Her MMP-9 results were positive, and she had significant staining and dropout of meibo- mian glands. The patient's mean keratom- etry measurement was 44.2, and she had 1.18 D of cylinder (Figure 1). I began by treating her with artificial tears, loteprednol 0.5% four times a day, and a T-cell modulator twice a day. We treated her meibomian gland disease with thermal pulsation and omega-3 supplements (2 g/day). Two weeks later, her eyes were more comfortable. There was also a significant difference in cor- neal topography (Figure 2). The axis changed, she had 2.35 D of cylinder, and her mean keratome- try was 44.49. After implantation of a toric intraocular lens, she was treatment before it reaches this stage. Dry eye is multifactorial. Depending on the type of dry eye and severity, we can choose from topical steroids, punctal occlusion, omega-3 supplements, cyclosporine, and lifitegrast. For patients with primary meibo- mian gland disease, I usually prefer thermal expression, which rapidly returns gland function. Patients often do not use hot compresses when they are recom- mended. I also recommend and prescribe an eyelid cleanser with hypochlorous acid and oral re-es- terified omega-3 supplements. Case report A 67-year-old woman had cata- racts in both eyes, and her vision was a bit hazy. She was contact lens intolerant, a key indicator of ocular surface disease, although allergies or other conditions may Corneal topography is an im- portant diagnostic before surgery. When correlated with the exam- ination, an irregular surface may confirm a diagnosis of dry eye. Dry eye treatment The 2016 ASCRS Clinical Survey revealed that 93% of members think mild to moderate dry eye impacts satisfaction after cataract or refractive surgery. However, 74% of members use artificial tears and lubricants to treat dry eye. Only 10% use cyclosporine or thermal expression, and 28% use omega-3 supplements. Tears can be useful in treating symptoms, but dry eye is a progressive disease. I prefer definitive therapies to treat the cause of the disease early rather than palliative treatments. Patients with severe dry eye do not respond as well to treatment, so we need to begin Figure 1. Dry eye disease affecting preoperative topography measurements Figure 2. Corneal topography after treatment of dry eye Irregular cornea IOLMaster Ks: 44.80 @ 90º/43.62 @ 180º CYL: 1.18 D Mean K 44.20 Bow tie astigmatism IOLMaster Ks: 45.66 @ 104º/43.31 @ 180º CYL: 2.35 D Mean K 44.49 continued from page 1

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